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In-Depth From A.D.A.M. Symptoms

People with peripheral artery disease (PAD) may or may not have symptoms. Because of silent symptoms, many cases of PAD go undiagnosed.

Intermittent Claudication

Claudication comes from the Latin word "to limp." Claudication is crampy leg pain that occurs during exercise, especially walking. The pain is due to insufficient blood flow in the legs (caused by blocked arteries). Intermittent means the pain comes and goes. Intermittent claudication is the most prominent symptom of PAD. About a third to a half of patients with PAD have this symptom.

Symptoms may be felt as pain, achiness, a sense of fatigue, or nonspecific discomfort that occurs with exercise. Symptoms should go away only with rest, within several minutes. Symptoms may only initially be present when walking uphill, walking faster, or walking for longer distances.

Because the most frequently affected artery in intermittent claudication is the popliteal artery, symptoms are most common in the calf muscles. This artery leads off from the femoral artery (the major artery in the thigh). It continues below the knee where it branches off and carries blood to the muscles in the calf and foot. Talk to your doctor about any leg or thigh pain you have.

Leg pain occurs in one leg in 40% of patients and in both legs in 60% of patients. Patients may also have fatigue or pain in the thighs and buttocks.

There is also some evidence that people with PAD have blood cells that are prone to forming clots.

Advanced Peripheral Artery Disease (Ischemic Rest Pain)

In advanced cases, the arteries are so blocked that even rest does not help. Leg pain that continues when lying down is called ischemic rest pain. Ischemia is the medical term for insufficient blood flow to tissues.

Typical symptoms may include:

Pain or tingling in the foot or toes, which may be so severe that even the weight of clothes or bed sheets cause or worsen the discomfort

Pain worsens when leg is elevated and improves by dangling legs over the side of the bed

People with ischemic rest pain are at risk for ulcers and gangrene. In severe cases, amputation may be required.

Other signs of advanced PAD can include:

Calf muscles that shrink (wither)

Hair loss over the toes and feet

Thick toenails

Shiny, tight skin

Painful non-bleeding ulcers on the feet or toes (usually black) that are slow to heal

Sometimes, blood clots form in the arteries in the legs, producing abrupt symptoms.

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